• COLORECTAL ADENOMAS
• COLORECTAL CANCER
• DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY
• SCREENING

Colon capsule endoscopy (CCE) is a modern, non-invasive method for large bowel visualization, offering a less invasive alternative to traditional colonoscopy (TC). While TC remains the gold standard for comprehensive large bowel assessment, including the detection and treatment of various conditions, the effectiveness of CCE in detecting polyps is less established.

To systematically review and compare the polyp detection rates (PDR) of CCE and TC.

A systematic literature search was conducted using four scientific databases: CINAHL, MEDLINE via EBSCO, Cochrane Library, and MEDLINE/PubMed. A standardized search command was utilized to ensure consistency. Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old. A meta-analysis was then conducted using the meta package in R software.

Initially, 339 articles were identified, with 128 duplicates and 15 non-English articles excluded, leaving 196 for screening. After further exclusions, 9 articles were included in the review. The meta-analysis revealed minimal differences in PDR between CCE and TC. The pooled PDR for TC was 0.61 (95%CI: 0.48–0.72), and for CCE, it was 0.61 (95%CI: 0.48–0.73). The overall comparison of the pooled PDR of both methods was 0.96 (95%CI: 0.90–1.02), indicating that CCE is non-inferior to TC.

CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection, demonstrating non-inferiority when compared to the conventional method.

• Colon capsule endoscopy
• Colonoscopy
• Polyp detection rate
• Polyp
• Adenoma
• Colorectal cancer

• Atmo Gas Capsule
• PillCam® system
• SmartPill™
• Technology Readiness Level
• biomarkers; C-scan system
• e-Celsius®
• gastrointestinal diagnostics
• non-WL technologies
• wireless capsule endoscopy

• CT colonography
• bowel preparation
• colon capsule endoscopy
• colorectal cancer
• completion rate
• inflammatory bowel disease
• ulcerative colitis

• gastrointestinal
• ingestible capsule
• motility
• transit time

• CT colonoscopy
• Colitis
• Colon Capsule Endoscopy
• Colonoscopy
• Colorectal polyps
• Inflammatory bowel disease

• Crohn’s disease
• capsule endoscopy
• diagnostic imaging
• ulcerative colitis

Colon screening programs have reduced colon cancer mortality. Population screening should be minimally invasive, safe, acceptably sensitive, cost-effective, and scalable. The range of screening modalities include guaiac or immunochemical fecal occult blood testing and CT colonography and colonoscopy. A number of carefully controlled studies concur that second-generation capsule endoscopy has excellent sensitivity for polyp detection and a high negative predictive value. Colon capsules fulfill the screening expectation of safety, high sensitivity for polyp detection, and patient acceptance, and appear to straddle the divide between occult blood testing and colonoscopy. While meeting these criteria, there remains the challenges of scaling, capsule practitioner training, resource allocation, and implementing change of practice. Like CT colonography, capsule screening presents the clinician with a decision on the threshold for colonoscopy referral. Overall, colon capsules are an invaluable tool in polyp detection and colon screening and offer a filter that determines “who needs a colonoscopy?”.

Background and aims: The applicability of colon capsule endoscopy in daily practice is limited by the accompanying labor-intensive reviewing time and the risk of inter-observer variability. Automated reviewing of colon capsule endoscopy images using artificial intelligence could be timesaving while providing an objective and reproducible outcome. This systematic review aims to provide an overview of the available literature on artificial intelligence for reviewing colonic mucosa by colon capsule endoscopy and to assess the necessary action points for its use in clinical practice. Methods: A systematic literature search of literature published up to January 2022 was conducted using Embase, Web of Science, OVID MEDLINE and Cochrane CENTRAL. Studies reporting on the use of artificial intelligence to review second-generation colon capsule endoscopy colonic images were included. Results: 1017 studies were evaluated for eligibility, of which nine were included. Two studies reported on computed bowel cleansing assessment, five studies reported on computed polyp or colorectal neoplasia detection and two studies reported on other implications. Overall, the sensitivity of the proposed artificial intelligence models were 86.5–95.5% for bowel cleansing and 47.4–98.1% for the detection of polyps and colorectal neoplasia. Two studies performed per-lesion analysis, in addition to per-frame analysis, which improved the sensitivity of polyp or colorectal neoplasia detection to 81.3–98.1%. By applying a convolutional neural network, the highest sensitivity of 98.1% for polyp detection was found. Conclusion: The use of artificial intelligence for reviewing second-generation colon capsule endoscopy images is promising. The highest sensitivity of 98.1% for polyp detection was achieved by deep learning with a convolutional neural network. Convolutional neural network algorithms should be optimized and tested with more data, possibly requiring the set-up of a large international colon capsule endoscopy database. Finally, the accuracy of the optimized convolutional neural network models need to be confirmed in a prospective setting.

• CC-CLEAR
• bowel preparation
• colon capsule
• multicentric validation
• quality criteria

• Cathartics
• Cohort Studies
• Colon/pathology
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonoscopy
• Humans

• Colorectal cancer
• DNA methylation
• DNA mutation
• circulating tumor cells
• colon capsule endoscopy
• cost effectiveness
• microRNA
• microbial markers
• screening
• virtual colonoscopy

• Odense University Hospital’s innovation fund
• Aage and Johanne Louis-Hansen’s Fond
• the Danish Cancer Society
• Medtronic Research Foundation
• the Excellence Centre in the Region of Southern Denmark
• Medtronic VR

• Algorithms
• Capsule Endoscopy/methods
• Deep Learning
• Humans
• Prospective Studies
• Sensitivity and Specificity

• Capsule Endoscopy/methods
• Colon/diagnostic imaging
• Colon/surgery
• Colonoscopy/methods
• Gastrointestinal Transit
• Humans
• Metoclopramide

Image-enhanced endoscopy is useful for diagnosing and identifying lesions in the gastrointestinal tract. Recently, image-enhanced endoscopy has become a breakthrough technology that has attracted significant attention. This image enhancing technology is available for capsule endoscopy, which is an effective tool for small intestinal lesions and has been applied in flexible spectral color enhancement technology and in contrast capsule like narrow-band imaging. In this field, most researchers focus on improving the visibility and detection of small intestinal lesions. This review summarizes previous studies on image-enhanced capsule endoscopy and aims to evaluate the efficacy of this technology.

• capsule endoscopy
• contrast capsule
• flexible spectral color enhancement
• image-enhanced endoscopy
• small intestinal lesions

Incomplete excretion rates are problematic for colon capsule endoscopy (CCE). Widely available booster regimens are suboptimal. Recently published data on one day preparation CCE protocol using castor oil appeared effective.

To assess the impact of adding castor oil to a standard split-dose (2-d) preparation in an unselected Western patient cohort.

All patients aged 18 or more referred to our unit for a CCE over a 5-mo period were prospectively recruited. Controls were retrospectively identified from our CCE database. All patients received split bowel preparation with Moviprep^® [polyethylene glycol (PEG)-3350, sodium sulphate, sodium chloride, potassium chloride, sodium ascorbate and ascorbic acid for oral solution; Norgine B. V, United States], a PEG-based solution used predominantly in our colonoscopy practice. Control booster regimen included Moviprep^® with 750 mL of water (booster 1) on reaching the small bowel. A further dose of Moviprep^® with 250 mL of water was given 3 h later and a bisacodyl suppository (Dulcolax^®) 10 mg after 8 h, if the capsule was not excreted. In addition to our standard booster regimen, cases received an additional 15 mL of castor oil given at the time of booster 1. A nested case control design with 2:1 ratio (control:case) was employed. Basic demographics, completion rates, image quality, colonic transit time, diagnostic yield and polyp detection were compared between groups, using a student t or chi-square tests as appropriate.

One hundred and eighty-six CCEs [mean age 60 years (18-97), 56% females, n = 104], including 62 cases have been analysed. Indication breakdown included 96 polyp surveillance (51.6%), 42 lower gastrointestinal symptoms (22.6%), 28 due to incomplete colonoscopy (15%), 18 anaemia (9.7%) and 2 inflammatory bowel disease surveillance (1.1%). Overall, CCE completion was 77% (144/186), image quality was adequate/diagnostic in 91% (170/186), mean colonic transit time was 3.5 h (0.25-13), and the polyp detection rate was 57% (106/186). Completion rates were significantly higher with castor oil, 87% cases (54/62) vs 73% controls (90/124), P = 0.01. The number needed to treat with castor oil to result in an additional complete CCE study was 7, absolute risk reduction = 14.52%, 95% confidence interval (CI): 3.06- 25.97. This effect of castor oil on excretion rates was more significant in the over 60 s, P < 0.03, and in females, P < 0.025. Similarly, polyp detection rates were higher in cases 82% (51/62) vs controls 44% (55/124), P = 0.0001, odds ratio 5.8, 95%CI: 2.77-12.21. Colonic transit times were similar, 3.2 h and 3.8 h, respectively. Image quality was similar, reported as adequate/ diagnostic in 90% (56/62) vs 92% (114/124).

In our capsule endoscopy centre, castor oil addition as a CCE booster significantly improved completion rates and polyp detection in an unselected Western cohort.

• Castor oil
• Colon capsule endoscopy
• Bowel preparation
• Completion rates
• Excretion rates

• colonic adenomas
• colonic polyps
• colorectal cancer screening
• endoscopic procedures

• Adenomatous Polyps/diagnosis
• Age of Onset
• Colonoscopy/standards
• Colorectal Neoplasms/genetics
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/prevention & control
• Female
• Global Health
• Humans
• Male
• Mass Screening/methods
• Mass Screening/statistics & numerical data
• Occult Blood
• Prevalence
• Risk Factors

• Capsule Endoscopy
• Colonic Polyps/diagnostic imaging
• Colonoscopy
• Colorectal Neoplasms/diagnostic imaging
• Humans
• Occult Blood

In the constantly developing era of minimal diagnostic invasiveness, the role of colon capsule endoscopy in colonic examination is being increasingly recognised, especially in the context of curtailed endoscopy services due to the COVID-19 pandemic. It is a safe diagnostic tool with low adverse event rates. As with other endoscopic modalities, various colon capsule endoscopy scores allow the standardisation of reporting and reproducibility. As bowel cleanliness affects CCE’s diagnostic yield, a few operator-dependent scores (Leighton–Rex and CC-CLEAR scores) and a computer-dependent score (CAC score) have been developed to grade bowel cleanliness objectively. CCE can be used to monitor IBD mucosal disease activity through the UCEIS and the panenteric CECDAIic score for UC and CD, respectively. CCE may also have a role in CRC screening, given similar sensitivity and specificity rates to conventional colonoscopy to detect colonic polyps ≥ 10 mm and CRC. Given CCE’s diagnostic yield and reproducible clinical scores with high inter-observer agreements, CCE is fast becoming a suitable alternative to conventional colonoscopy in specific patient populations.

• bowel preparation
• colon capsule endoscopy
• colonoscopy
• endoscopy score
• inflammatory bowel disease
• inter-observer agreement
• minimally invasive
• polyps

• capsule endoscopy
• colonoscopy
• colorectal cancer
• inflammatory bowel disease
• polyethylene glycol

• Artificial Intelligence
• Capsule Endoscopy
• Colon
• Colonoscopy
• Colorectal Neoplasms/diagnostic imaging
• Humans
• Japan

• cancer
• colorectal cancer
• epidemiology
• risk factors
• symptoms

• colonoscopy
• colorectal cancer
• familial history
• fecal immunochemical test
• screening

• Institut National Du Cancer

• Imaging
• Innovation
• Small intestine
• Video capsule endoscopy

• Capsule Endoscopy
• Gastrointestinal Hemorrhage
• Gastrointestinal Transit
• Humans

• capsule endoscopy
• enterocolitis
• immune checkpoint inhibitors
• observational study
• prospective studies

• CT colonography
• colon cancer
• colon capsule endoscopy
• colonoscopy
• colorectal cancer
• computed tomography colonography
• incomplete investigation
• meta-analysis
• polyps
• systematic review

Colonic capsule endoscopy (CCE) derived from the video capsule endoscopy, initially proposed to explore the small bowel, has demonstrated high sensitivity and specificity for colonic polyp detection. The primary outcome of the study was to assess the safety, feasibility, and reliability of CCE after colorectal surgery. Secondary outcomes were to identify the detection rate of colonic lesions and recognition of the surgical anastomosis as compared to colonoscopy.

This is a prospective single-center study conducted over a 2-year period. Thirty-seven patients with a history of colorectal surgery were prospectively included in this study. Each patient received both CCE and colonoscopy, performed by different operators blinded to each other’s results.

Thirty-two patients (86.5%) completed the study and were included in the final analysis. All capsules were naturally expelled. In three patients (9.4%), the anal verge was not identified during the CCE recording and the examination of the colon was considered incomplete. Surgical anastomosis was accurately identified by CCE in 78.2% of the patients versus 93.8% for colonoscopy (P = 0.65). Thirty-eight lesions were detected in 14 patients. The sensitivity of CCE to detect colonic polyps was 95.2% (95% confidence interval (CI): 77.3-99.2%), the specificity 82.4% (95% CI: 59.0-93.8%). Positive predictive value (PPV) and negative predictive value (NPV) of CCE to detect colonic polyps were 87.0% and 93.3%, respectively. No complications related to the passage of the capsule through the intestinal anastomosis were detected.

CCE proved to be safe and feasible, reporting a similar detection rate of colonic lesion compared to colonoscopy.

• Colonic anastomosis
• Colonic capsule endoscopy
• Colonoscopy
• Colorectal cancer screening
• Follow-up after colorectal surgery
• Video

• FIT
• colorectal cancer
• cost-effectiveness
• screening

• Institut National Du Cancer

• CT colonography
• Colon capsule endoscopy
• Colorectal cancer screening

• Colon capsule endoscopy
• Inflammatory bowel disease
• Preparation

Capsule endoscopy has revolutionized the management of small-bowel diseases owing to its convenience and noninvasiveness. Capsule endoscopy is a common method for the evaluation of obscure gastrointestinal bleeding, Crohn’s disease, small-bowel tumors, and polyposis syndrome. However, the laborious reading process, oversight of small-bowel lesions, and lack of locomotion are major obstacles to expanding its application. Along with recent advances in artificial intelligence, several studies have reported the promising performance of convolutional neural network systems for the diagnosis of various small-bowel lesions including erosion/ulcers, angioectasias, polyps, and bleeding lesions, which have reduced the time needed for capsule endoscopy interpretation. Furthermore, colon capsule endoscopy and capsule endoscopy locomotion driven by magnetic force have been investigated for clinical application, and various capsule endoscopy prototypes for active locomotion, biopsy, or therapeutic approaches have been introduced. In this review, we will discuss the recent advancements in artificial intelligence in the field of capsule endoscopy, as well as studies on other technological improvements in capsule endoscopy.

• Artificial intelligence
• Capsule endoscopy
• Convolutional neural network
• Locomotion

• CRC screening
• CT colonography
• Capsule colon
• Sigmoidoscopy
• Virtual colonoscopy

• COVID-19
• Colon Capsule Endoscopy
• colonoscopy

• artificial intelligence
• colorectal cancer screening
• computer-aided diagnosis for colonoscopy
• robotic colonoscopy
• robotics for medical distancing

• Colon capsule endoscopy
• Colonoscopy
• Colorectal cancer
• Polyp

• Capsule Endoscopy/instrumentation
• Colonic Diseases/diagnostic imaging
• Colonoscopy/instrumentation
• Colonoscopy/methods
• Humans

• Adenoma/diagnosis
• Adenoma/pathology
• Aged
• Capsule Endoscopy/methods
• Carcinoma/diagnosis
• Carcinoma/pathology
• Colonic Polyps/diagnosis
• Colonic Polyps/pathology
• Colonoscopy/methods
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/pathology
• Early Detection of Cancer
• Feces/chemistry
• Female
• Humans
• Immunochemistry
• Male
• Middle Aged
• Predictive Value of Tests
• Sensitivity and Specificity

• diagnostic and therapeutic endoscopy
• endoscopy
• gastrointesinal endoscopy

Since its original application, gastrointestinal (GI) endoscopy has undergone many innovative transformations aimed at expanding the scope, safety, accuracy, acceptability and cost-effectiveness of this area of clinical practice. One method of achieving this has been to reduce the caliber of endoscopic devices. We propose the collective term “Miniature GI Endoscopy”. In this Opinion Review, the innovations in this field are explored and discussed. The progress and clinical use of the three main areas of miniature GI endoscopy (ultrathin endoscopy, wireless endoscopy and scanning fiber endoscopy) are described. The opportunities presented by these technologies are set out in a clinical context, as are their current limitations. Many of the positive aspects of miniature endoscopy are clear, in that smaller devices provide access to potentially all of the alimentary canal, while conferring high patient acceptability. This must be balanced with the costs of new technologies and recognition of device specific challenges. Perspectives on future application are also considered and the efforts being made to bring new innovations to a clinical platform are outlined. Current devices demonstrate that miniature GI endoscopy has a valuable place in investigation of symptoms, therapeutic intervention and screening. Newer technologies give promise that the potential for enhancing the investigation and management of GI complaints is significant.

• Ultrathin endoscopy
• Capsule endoscopy
• Single fiber endoscopy

• Biomedical Technology/methods
• Biomedical Technology/trends
• Endoscopy, Gastrointestinal/instrumentation
• Endoscopy, Gastrointestinal/methods
• Endoscopy, Gastrointestinal/trends
• Equipment Design/trends
• Gastrointestinal Diseases/diagnosis
• Gastrointestinal Diseases/therapy
• Humans
• Inventions
• Mass Screening/instrumentation
• Mass Screening/methods
• Mass Screening/trends
• Miniaturization/methods